scholarly journals Association of a Clinician’s Antibiotic-Prescribing Rate With Patients’ Future Likelihood of Seeking Care and Receipt of Antibiotics

2020 ◽  
Author(s):  
Zhuo Shi ◽  
Michael L Barnett ◽  
Anupam B Jena ◽  
Kristin N Ray ◽  
Kathe P Fox ◽  
...  
Keyword(s):  
United States ◽  
Clinical Improvement ◽  
Care Center ◽  
Family Members ◽  
Patient Characteristics ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Random Assignment ◽  
Urgent Care Center ◽  
Respiratory Illnesses

Abstract Background One underexplored driver of inappropriate antibiotic prescribing for acute respiratory illnesses (ARI) is patients’ prior care experiences. When patients receive antibiotics for an ARI, patients may attribute their clinical improvement to the antibiotics, regardless of their true benefit. These experiences, and experiences of family members, may drive whether patients seek care or request antibiotics for subsequent ARIs. Methods Using encounter data from a national United States insurer, we identified patients <65 years old with an index ARI urgent care center (UCC) visit. We categorized clinicians within each UCC into quartiles based on their ARI antibiotic prescribing rate. Exploiting the quasi-random assignment of patients to a clinician within an UCC, we examined the association between the clinician’s antibiotic prescribing rate to the patients’ and their spouses’ rates of ARI antibiotic receipt in the subsequent year. Results Across 232,256 visits at 736 UCCs, ARI antibiotic prescribing rates were 42.1% and 80.2% in the lowest and highest quartile of clinicians, respectively. Patient characteristics were similar across the four quartiles. In the year after the index ARI visit, patients seen by the highest-prescribing clinicians received more ARI antibiotics (+3.0 fills/100 patients (a 14.6% difference), 95% CI 2.2–3.8, P < 0.001,) versus those seen by the lowest-prescribing clinicians. The increase in antibiotics was also observed among the patients’ spouses. The increase in patient ARI antibiotic prescriptions was largely driven by an increased number of ARI visits (+5.6 ARI visits/100 patients, 95% CI 3.6–7.7, P < 0.001), rather than a higher antibiotic prescribing rate during those subsequent ARI visits. Conclusions Receipt of antibiotics for an ARI increases the likelihood that patients and their spouses will receive antibiotics for future ARIs.

scholarly journals Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010–2014

2017 ◽  
Vol 23 (2) ◽  
pp. 367-369 ◽  
Author(s):  
William S. Pearson ◽  
Guoyu Tao ◽  
Karen Kroeger ◽  
Thomas A. Peterman
Keyword(s):  
United States ◽  
Sexually Transmitted Infections ◽  
Care Center ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Sexually Transmitted

scholarly journals 2060. Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S694-S694
Author(s):  
Amy Fabian ◽  
Sara Linnertz ◽  
Lisa Avery
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Care Center ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Composite Outcome ◽  
Post Intervention ◽  
Urgent Care Center ◽  
Tract Infections

Abstract Background The urgent care center (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTIs), skin and soft-tissue infections (SSTIs), upper respiratory tract infections (URIs), and lower respiratory tract infections (LRTIs) before, during, and after the presence of an AS pharmacist in an UC. Methods Single-center, retrospective, observational, pre (December 10, 2018–January 6, 2019), intervention (January 7–February 3, 2019), and post-intervention (February 4–March 3, 2019) study. All non-pregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, presented for a follow-up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Noncompliance (NC) was a composite endpoint of non-guideline adherent antibiotic prescribing for viral infections, inappropriate empiric selection, duration, and/or dosage. Secondary outcomes include composite outcome components and subgroup analysis of disease states. Results A total of 1,930 patients were screened with 439,440, and 430 patients included in the pre, intervention, and post-intervention group. Demographics were similar between groups, except for age (P = 0.001) and influenza diagnoses (P < 0.001). NC decreased from 43.3% to 31.1% (P = 0.0002) pre-intervention to intervention and from 31.1% to 26.5% (P = 0.14) post-intervention. Pre-intervention to intervention resulted in a change in composite outcome components of non-compliant prescribing (18.9% to 13%, P = 0.02), empiric selection (8.7% to 5.9%, P = 0.12), duration (4.1% to 5.9%, P = 0.28), dosage (3.4% to 0.5%, P = 0.001), and multiple components for NC (8.2% to 6.4%, P = 0.3). Reductions in NC were seen for UTI (83.3% to 69.2%, P = 0.26), SSTI (45.7% to 42.9%, P = 1.0), URI (23.5% to 23.2%, P = 1.0), and LRTI (82.1% to 51.6%, P = 0.0004). Conclusion An AS pharmacist’s presence in a UC significantly reduced NC to antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center

2019 ◽  
Vol 6 ◽  
pp. 2333794X1983563
Author(s):  
Rebecca Hayes ◽  
Brandon Merritt ◽  
Stacee Lewis ◽  
Jessie Shields ◽  
Jennifer Gerlach ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Care Center ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Urgent Care Center ◽  
Primary Care Office ◽  
Upper Respiratory ◽  
Urgent Care Setting

It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians’ antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.

scholarly journals Urgent Care Center and Retail Health Clinic Utilization Among Adults: United States, 2019

2021 ◽  
Author(s):  
Lindsey Black ◽  
Dzifa Adjaye-Gbewonyo
Keyword(s):  
United States ◽  
Care Center ◽  
Urgent Care ◽  
Health Clinic ◽  
Urgent Care Center ◽  
The Past ◽  
Clinic Visits

This report examines urgent care center or retail health clinic visits among adults in the past 12 months by sex and selected characteristics.

scholarly journals 23. Regional Variation in Outpatient Antibiotic Prescribing in a Commercially-insured Population, United States, 2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S12-S12
Author(s):  
Destani J Bizune ◽  
Danielle Palms ◽  
Laura M King ◽  
Monina Bartoces ◽  
Ruth Link-Gelles ◽  
...  
Keyword(s):  
United States ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tier 2 ◽  
Regional Variability ◽  
Patient Age ◽  
Patient Âgé ◽  
Tier 3

Abstract Background Studies have shown that the Southern United States has higher rates of outpatient antibiotic prescribing compared to other regions in the country, but reasons for this variation are unclear. We aimed to determine whether the regional variability in outpatient antibiotic prescribing for respiratory diagnoses can be explained by differences in patient age, care setting, comorbidities, and diagnosis in a commercially-insured population. Methods We analyzed the 2017 IBM® MarketScan® Commercial Database of commercially-insured individuals aged &lt; 65 years. We included visits with acute respiratory tract infection (ARTI) diagnoses from retail clinics, urgent care centers, emergency departments, and physician offices. ARTI diagnoses were categorized as: Tier 1, antibiotics are almost always indicated (pneumonia); Tier 2, antibiotics are sometimes indicated (sinusitis, acute otitis media, pharyngitis); and Tier 3, antibiotics are not indicated (asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative otitis media, viral upper respiratory infections, viral pneumonia). We calculated risk ratios and 95% confidence intervals (CI) stratified by US Census region and ARTI tier using log-binomial models controlling for patient age, comorbidities (Elixhauser and Complex Chronic Conditions for Children), and setting of care, with Tier 3 visits in the West, the strata with the lowest antibiotic prescription rate, as the reference for all strata. Results A total of 100,104,860 visits were analyzed. In multivariable modeling, ARTI visits in the South and Midwest were highly associated with receiving an antibiotic for Tier 2 conditions vs. patients in other regions (Figure 1). Figure 1. Multivariable model comparing risk of receiving an antibiotic for an ARTI by region and diagnostic tier in urgent care, retail health, emergency department, and office visits, MarketScan® 2017, United States Conclusion Regional variability in outpatient antibiotic prescribing for Tier 2 and 3 ARTIs remained even after controlling for patient age, comorbidities, and setting of care. It is likely that this variability is in part due to non-clinical factors such as regional differences in clinicians’ prescribing habits and patient expectations. Targeted and enhanced public health stewardship interventions are needed to address cultural factors that affect antibiotic prescribing in outpatient settings. Disclosures All Authors: No reported disclosures

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